title: Retroperitoneal bleeding after cardiac catheterization: a 7-year descriptive single-center experience.
abstract: BACKGROUND
  Retroperitoneal bleeding (RPB) is an unusual but potentially fatal vascular complication occurring after cardiac catheterization (CC). Contemporary data of RPB in the era of dual antiplatelet therapy and vascular closure devices are lacking.
  
  
  METHODS
  We retrospectively examined all RPB cases that occurred after CC in the Rabin Medical Center between the years 2005 and 2011.
  
  
  RESULTS
  Of 26,487 patients who underwent CC, a total of 48 patients (mean age 60.9 ± 13.8 years, 52.1% female) with RPB were identified (0.18%). The indication for CC was acute coronary syndrome (43.7%), myocardial infarction (35.4%), stable angina pectoris (8.3%), hemodynamic studies for valvular heart disease (10.4%) and others (2.1%). Coronary intervention was performed in 34 patients (70.9%) and a vascular closure device (VCD) was used in 16 patients (33.3%). Seventy-seven percent of patients were treated with clopidogrel, 20.8% with glycoprotein IIb-IIIa inhibitors and 85.4% with anticoagulation during CC. Median time to diagnosis of bleeding was 9.0 h, while the median time to bleeding differed between patients with and without a VCD (12 vs. 5 h, respectively). The clinical presentation of RPB was hemorrhagic shock in 39.6% of patients and 50.0% required at least one blood transfusion. Patients were managed either with conservative treatment (79.2%), angiography stenting (14.6%) or vascular surgery (6.2%). A total of 3 patients died during hospitalization, of which RPB was the etiology in 2 (4.2%).
  
  
  CONCLUSIONS
  RPB which is a rare complication of CC is associated with younger age and female gender, as compared to patients without RPB. Onset of bleeding can be delayed in patients with VCDs. With careful and early diagnosis, most patients with RPB after CC can be managed conservatively.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Katia
authors.initials: K
authors.lastname: Orvin
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D060050:Angina, Stable / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants